Publicity Authorization Release of Confidentiality Waiver Form

I hereby grant permission to Iowa Donor Network (IDN) or anyone authorized by Iowa Donor Network the use of the following for the purpose of professional education, public education, and/or promotion of organ/tissue donation. This includes, but is not limited to, IDN's Virtual Donor Memorial Wall, social media, website, and public and professional educations. This permission includes use of the photograph and story submitted by me along with this form as indicated below. I understand that as a result of this publicity I am waiving my right to confidentiality. I understand that if I am a donor family, my identity may be known to the recipient(s); I understand that if I am a recipient, my identity may be known to the donor family. 

In consideration of IDN’s facilitating this contact, I hereby release IDN, its officers, directors, agents, employees, volunteers, representatives, and consultants, from any and all claims I may at any time have against them, or which any member of my family may have, that result from or arise out of these communications or contacts. I hereby agree not to sue or commence any legal action against IDN and to indemnify and hold IDN harmless from and against all such claims, liabilities, demands, and expenses (including, without limit, reasonable attorneys’ fees and legal costs and disbursements) that arise out of, in connection with, or as a consequence of any such contacts or communications.

I understand granting of this permission is voluntary, the purpose of this permission has been explained to me and I have been given the opportunity to have any questions answered.